胸主动脉腔内修复术后截瘫发生的危险因素及处理

目的:探讨胸主动脉腔内修复术(TEVAR)后截瘫发生的危险因素及处理。方法:回顾性分析2011年5月—2015年5月593例行TEVAR手术的Stanford B型主动脉夹层患者资料,分析术后截瘫发生的危险因素并总结处理方法。结果:593例患者中,9例(1.5%)发生TEVAR术后截瘫。单变量分析结果显示,糖尿病、高血压、吸烟、围术期低血压和左锁骨下动脉封堵可能与TEVAR术后截瘫有关(均P0.05);多变量Logistic回归分析结果显示,围术期低血压是TEVAR术后截瘫的独立危险因素(P0.05)。所有截瘫患者经脑脊液引流、激素冲击、适当升压、抗凝、扩血管、营养神经、降颅压联合治疗后,神经系统功能均完全恢复。结论:围术期低血压是TEVAR后截瘫发生的重要危险因素。截瘫发生后早期采取相应保守治疗手段提高脊髓灌注可以有效改善预后。

Risk factors and management for paraplegia after thoracic endovascular aortic repair

Objective: To investigate the risk factors of paraplegia after thoracic endovascular aortic repair (TEVAR) and its management strategies. Methods: The clinical data of 593 patients with Stanford type B aortic dissection who underwent TEVAR between May 2011 and May 2015 were reviewed. The risk factors for postoperative paraplegia were analyzed and the treatment methods were summarized. Results: Among the 593 patients, post-TEVAR paraplegia occurred in 9 cases (1.5%). Univariate analysis showed that diabetes, hypertension, smoking, left subclavian artery occlusion, and perioperative hypotension were associated with post-TEVAR paraplegia (all P<0.05), and further multivariate Logistic regression analysis showed that perioperative blood pressure was the significant risk factor for paraplegia after TEVAR (P<0.05). The nervous system function was completely recovered in all the patients with post-TEVAR paraplegia after combined treatment that included cerebrospinal fluid drainage, hormone stosstherapy, appropriate blood pressure elevation, anticoagulation, vascular dilation, neuro-nutrition and lowering intracranial pressure Conclusion: Perioperative hypotension is an important risk factor for paraplegia after TEVAR. Early adoption of corresponding conservative treatments to increase spinal cord perfusion may effectively improve the results.